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Suicide Risk Linked to Multiple Brain Injuries

KAISERSLAUTERN, Germany — Deployed military personnel who’ve had multiple traumatic brain injuries from roadside bombs or other incidents may be at increased risk for suicide, a new study suggests.

Earlier research had already drawn a link between brain injuries and increased suicide risk, but the study published Wednesday by the Journal of the American Medical Association suggests the risk increases even further in personnel who’ve had more than one brain injury. However, the majority of those with multiple TBIs were not suicidal, the study found.

Study author Craig J. Bryan, a psychologist and former Air Force captain who is now associate director of the National Center for Veterans Studies at the University of Utah, said his findings, gleaned from data on 161 patients who came into his clinic in Balad, Iraq, in 2009, were somewhat surprising.

While the increase in suicidal thoughts among those who’d suffered multiple brain injuries was expected, it was interesting, he said, that the “dose effect” of multiple injuries appeared to level out after two injuries.

“I really was expecting guys who had been blown up or had sustained five or six concussions in their lives, they would probably look even worse or be at greater risk than the guys who had only sustained two TBIs,” Bryan said Tuesday in a phone interview, “but that was not the case.”

Personnel who visited Bryan’s clinic in Iraq after sustaining a suspected head injury, each completed a standardized assessment in which they reported feelings of depression, post-traumatic stress and suicidal thoughts and behaviors, as well as their lifetime history of traumatic brain injury, including concussions they had had as children.

Those who’d never had a TBI reported having no suicidal thoughts or behaviors, while 6.9 percent of those who’d had one TBI reported such feelings. Among those who’d had two or more injuries, 21.7 percent expressed suicidal thoughts or behaviors.

“I think these numbers could be disturbing to some of our servicemembers who know they’ve had brain injuries,” said John D. Corrigan, director of the Division of Rehabilitation Psychology and a professor in the Department of Physical Medicine and Rehabilitation at Ohio State University. He was not involved in the study.

But he cautioned those who’ve had an injury to keep in mind that the study only shows a relationship between TBI and suicidal thoughts and doesn’t consider factors that could mitigate suicide risk.

The most interesting finding, Corrigan said, is that, of those who’d never had a TBI, none reported suicidal thoughts. “I’ll be interested in looking a little closer at that.”

Bryan said his best guess for why none of the 18 servicemembers in the zero TBI group reported suicidal thoughts is that there weren’t enough people in the group to render an accurate result. In general, 2 percent to 3 percent of people will report having suicidal thoughts in the past year, he said, which equates to roughly 1 person in 40.

While those with multiple TBIs were “significantly more likely to be suicidal,” Bryan said, “the vast majority, 75 to 80 percent, of those who had multiple TBIs were not suicidal.”

Corrigan said he doesn’t know if this study alone is reason enough for the U.S. military to change its handling of traumatic brain injuries.

Its policy in Afghanistan of requiring personnel caught in vehicle rollovers and bombings to be pulled from the fight to undergo testing for brain injuries “appears to have had a very positive effect in terms of folks being able to heal quickly from the most minor of the traumatic brain injuries.”

“Probably what this does say,” Bryan said, “is that immediately following a head injury, whether from an explosion, a motor-vehicle accident, whatever the case may be, we definitely do need to take people out and give them a break.”